Principle Of Respect For Persons Research Articles

Active Respect and Critical Solidarity

ABSTRACT This article argues that, to distinguish between “critical” and “uncritical” solidarity, the normative concept of solidarity must be grounded on the principle of respect for persons. I start analyzing the principle of respect for persons from a modified Kantian perspective, arguing that it must be interpreted as a normative relation of power in which each person must recognize the autonomy of the other as a source of power. In this perspective, the principle of respect offers a foundation for an ethical assessment of situations in which ethical solidarity is required. By drawing on the distinction between passive and active respect, I argue that solidarity is grounded on the duty of active respect in the face of danger or oppression and that this foundation allows us to distinguish between critical (i.e. appropriate) and uncritical (i.e. inappropriate) solidarity.

Ethical applications of digital community-based research with Black immigrant and refugee youth and families.

The capacity to conduct psychology research online has expanded more quickly than have ethics guidelines for digital research. We argue that researchers must proactively plan ways to engage ethically in online psychological research with vulnerable groups, including marginalized and immigrant youth and families. To that end, this article describes the ethical use of internet and cell phone technologies in psychological research with Black immigrant and refugee youth and families, which demands efforts to both deepen and extend the Belmont principles of respect for persons, beneficence, and justice. We describe and apply four research frameworks-community-based participatory research, transdisciplinary team science, representational ethics, and cross-cultural psychology-that can be integrated to offer practical solutions to ethical challenges in digital research with Black immigrant and refugee youth and families. Then, as an illustration, we provide a case example of this approach using the Food, Culture, and Health Study conducted with Black Jamaican American and Somali American youth and families, who experience tridimensional acculturation due to their race and have been disproportionately impacted by the dual pandemics of COVID-19 and racism/Whiteness. We offer this article as a road map for other researchers seeking to conduct ethical digital community-based psychological research with Black immigrant youth and families and other marginalized communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ethical considerations in using sensors to remotely assess pediatric health behaviors.

Sensors, including accelerometer-based and electronic adherence monitoring devices, have transformed health data collection. Sensors allow for unobtrusive, real-time sampling of health behaviors that relate to psychological health, including sleep, physical activity, and medication-taking. These technical strengths have captured scholarly attention, with far less discussion about the level of human touch involved in implementing sensors. Researchers face several subjective decision points when collecting health data via sensors, with these decisions posing ethical concerns for users and the public at large. Using examples from pediatric sleep, physical activity, and medication adherence research, we pose critical ethical questions, practical dilemmas, and guidance for implementing health-based sensors. We focus on youth given that they are often deemed the ideal population for digital health approaches but have unique technology-related vulnerabilities and preferences. Ethical considerations are organized according to Belmont principles of respect for persons (e.g., when sensor-based data are valued above the subjective lived experiences of youth and their families), beneficence (e.g., with sensor data management and sharing), and justice (e.g., with sensor access and acceptability among minoritized pediatric populations). Recommendations include the need to increase transparency about the extent of subjective decision making with sensor data management. Without greater attention to the human factors involved in sensor research, ethical risks could outweigh the scientific promise of sensors, thereby negating their potential role in improving child health and care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ethical challenges in the use of digital technologies in psychological science: Introduction to the special issue.

Digital technologies are pervasive in every aspect of our daily lives. The proliferation of such technologies has also influenced the conduct of biomedical, behavioral, and social research. The articles in this special issue provide illustrative examples of the range of applications of digital technologies in psychological science research across a variety of populations. They highlight ethical, legal, and social issues that emerge when digital technologies are employed in psychological science research in the current era of rapid technological change, increasing prevalence of interdisciplinary team science, evolving understandings of ethical precepts and social norms, and promoting open science. This introduction to the special issue provides an overview of challenges to the Belmont principles of respect for persons, beneficence, and justice revealed in the 10 articles. The conclusions reached are that these ethical principles do not always adapt well to the digital environment and that practices cannot always be uniquely classified under one of these three headings. We recommend that conceptual work and practical guidance be undertaken to expand the interpretation of these principles in the light of evolving societal norms and emerging ethical issues. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attitudes among the Australian public toward AI and CCTV in suicide prevention research: A mixed methods study.

Research is underway exploring the use of closed-circuit television (CCTV) cameras and artificial intelligence (AI) for suicide prevention research in public locations where suicides occur. Given the sensitive nature and potential implications of this research, this study explored ethical concerns the public may have about research of this nature. Developed based on the principle of respect, a survey was administered to a representative sample of 1,096 Australians to understand perspectives on the research. The sample was aged 18 and older, 53% female, and 9% ethnic minority. Following an explanatory mixed methods approach, interviews and a focus group were conducted with people with a lived experience of suicide and first responders to contextualize the findings. There were broad levels of acceptance among the Australian public. Younger respondents, females, and those declining to state their ethnicity had lower levels of acceptance of CCTV research using AI for suicide prevention. Those with lived experience of suicide had higher acceptance. Qualitative data indicated concern regarding racial bias in AI and police response to suicidal crises and the need for lived experience involvement in the development and implementation of any resulting interventions. Broad public acceptance of the research aligns with the principle of respect for persons. Beneficence emerged in the context of findings emphasizing the importance of meaningfully including people with lived experience in the development and implementation of interventions resulting from this research, while justice emerged in themes expressing concerns about racial bias in AI and police response to mental health crises. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient priorities for fulfilling the principle of respect in research: findings from a modified Delphi study

BackgroundStandard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research.MethodsWe conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research.ResultsForty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect.ConclusionsInformed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research.

Redefining informed consent form in cell and gene therapy trials.

Informed consent is a foundation of the ethical conduct of research involving human participants. Based on the ethical principle of respect for persons, the goal of informed consent is to ensure that participants are aware of the risks and potential benefits and make a voluntary decision about participating in clinical trial research. The extraordinary scientific advances happening globally, have demonstrated the potential of regenerative therapies in transforming the health of the nation by providing a therapeutic option for diseases that were previously considered incurable. These therapies, which include cells and gene therapy (GT) labeled as Advanced Therapeutic Medicinal Products globally, have complex mechanisms of action. Owing to their highly personalized and intricate nature of these therapies, developing the latter often presents unique challenges above and beyond those encountered for small molecule drugs. We recently looked through some cell and GT clinical trials and realized the lacunae in the informed consent form (ICF) provided by the investigators. Especially in a country like India, where the general understanding and perception of patients is limited regarding clinical trials, it is felt that any lapses in the consent process may jeopardize the informed decision-making and safety of the participants and tarnish the reputation of India globally. The present article highlights the need for appropriate patient and public education on the various aspects of cell and gene therapies and aims to address all the elements of ICF in light of the challenges associated with these innovative therapies.

Vulnerability in Biomedical Research: A Historical Reflection and Practical Implications for HIV Cure-Related Research.

The concept of vulnerability in bioethics was first referenced in 1979, when the Belmont Report highlighted the need for special consideration of certain populations in the application of its general principles of respect for persons, beneficence, and justice in research with human participants. Since then, a body of literature has emerged regarding the content, status, and scope, as well as ethical and practical implications of vulnerability in biomedical research. The social history of HIV treatment development has at various points reflected and actively influenced bioethics' debate on vulnerability. In the late 1980s and early 1990s, people with AIDS activist groups drafted landmark patient empowerment manifestos like The Denver Principles, fighting to have greater involvement in the design and oversight of clinical trials related to HIV treatment, and in doing so, pushed against research ethics protocols created with the intention of protecting vulnerable populations. The determination of appropriate benefit/risk profiles in clinical trials was no longer limited to the purview of clinicians and scientists, but began to include the perspectives of people with HIV (PWH) and affected communities. In contemporary HIV cure-related research, where participants often risk health for no personal clinical benefit, the community's voiced motivations and objectives for participation continue to challenge population-based accounts of vulnerability. While the development of a framework for discussion and the establishment of clear regulatory requirements are necessary to support the practical and ethical conduct of research, they risk distraction from the fundamental value of voluntary participation and potentially overlook the unique history and perspectives of PWH in their participation in the quest toward an HIV cure.

Implementation of Ecological Solid Waste Management City Ordinance: The Case of a Component City in Southern Negros

Aims: This study determined the extent of implementation of ecological solid waste management activities: waste generation and storage, waste processing and resources recovery, collection and transportation, and disposal of solid wastes in communities in a component city in Negros Occidental as assessed by the city implementers, barangay implementers, and residents when taken as a whole and when barangays are grouped according to geographical location, population, land area, and income classification. Lastly, the findings of the study were utilized in the formulation of a strategic plan for enhanced implementation of the city's comprehensive solid waste management program. 
 Study Design:  The study utilized the quantitative design particularly the descriptive-comparative approach.
 Place and Duration of Study: The study was conducted in the barangays of a component city in Southern part of Negros Occidental Philippines during school year 2022.
 Methodology: The study used a descriptive-comparative research design utilizing a survey questionnaire for data collection.  Only Five hundred thirteen (513) respondents participated in the study and the seven (7) others refused to answer the survey questionnaire.  Total enumeration was employed for city implementers.  Stratified random sampling was used to identify the respondents for barangay and community leaders for each stratum to be well represented.  Purposive sampling was used in data collection.  In the same way, purposive sampling was used in the conduct of interviews.  To analyze the descriptive data, Mean, Standard Deviation, and Frequency Count were also used.  Kruskal Wallis and Mann-Whitney U tests were utilized for comparative analysis.  More so, general moral principles of respect for persons, beneficence, and justice to ensure the ethical soundness of the study are addressed in the study.
 Results: The result shows no significant difference in the implementation when communities are grouped according to population.  However, a significant difference was found when communities were grouped according to location, land area, and income.  When it comes to demographics of the respondents in the component city in Southern Negros.  In terms of respondents, 1.8% (f=9) were city implementers, 25.0% (f=128) were barangay implementers, and 73.3% (f=193) were community leaders. Among the three (3) implementers, the majority were the community leaders in the component city.  Meanwhile, in regards to location, 40.0% (f=205) of respondents came from upland location, 37.6% (f=193) stayed at mainland, and 22.4% (f=115) lived in coastal location. Dominantly, respondents from the upland location obtained the highest percentage among the location. When it comes to population, 73.9% (f=379) belonged to the smaller population with 5933 and below, and 26.1% (f=134) was from a bigger population with 5934 and above.  The majority belonged to a smaller population that dominated the study.  Similarly, in terms of land area, 73.9% (f=379) of the respondents were from a smaller area (1931 and below), while 26.3% (f=135) were from a bigger area (1932 and up). Finally, in terms of income classification, 68.6% (f=352) of respondents belonged to the barangays with a lower income of 806880 and below, while 31.4% (f=68.4) belonged to the barangays with a higher income of 8068808 and up.  Respondents residing in lower-income areas have fewer sources of living, income, and resources.

Steering into the Curves: Using Diagnosis to Support the Dignity and Autonomy of Trans Youth.

This response to Kariyawasam and Rai affirms their critique of the pathologization of trans youth but forecasts a foreseeable negative outcome of their proposed elimination of diagnosis as a prerequisite to gender-affirming care (GAC) - the risk of removing GAC entirely from the medical sphere and compromising the wellbeing of those transgender individuals for whom GAC is deeply affirming. We suggest an ethical framework of GAC that expands past a focus on autonomy to incorporate a principle of respect for persons that affirms the dignity and diversity of trans youth - recognizing the need to facilitate both medical assistance and social change.

Comparative sensitivity of social media data and their acceptable use in research

Social media data offer a rich resource for researchers interested in public health, labor economics, politics, social behaviors, and other topics. However, scale and anonymity mean that researchers often cannot directly get permission from users to collect and analyze their social media data. This article applies the basic ethical principle of respect for persons to consider individuals’ perceptions of acceptable uses of data. We compare individuals’ perceptions of acceptable uses of other types of sensitive data, such as health records and individual identifiers, with their perceptions of acceptable uses of social media data. Our survey of 1018 people shows that individuals think of their social media data as moderately sensitive and agree that it should be protected. Respondents are generally okay with researchers using their data in social research but prefer that researchers clearly articulate benefits and seek explicit consent before conducting research. We argue that researchers must ensure that their research provides social benefits worthy of individual risks and that they must address those risks throughout the research process.

Trash talk and Kantian values

ABSTRACT In this paper, I argue for a nuanced, context-sensitive approach to the question of trash talk, based on the Kantian principle of respect for persons and an emphasis on first-person action-guidance. I also suggest that we understand trash talk to have several varieties. On my proposed approach, there is no simple answer to the question of whether trash talk is morally permissible; rather, context-sensitive judgment can help us to determine what we ought to do when the possibility of various forms of trash talk arises.

Review of For the Common Good: Philosophical Foundations of Research Ethics

Review of For the Common Good:Philosophical Foundations of Research Ethics Douglas MacKay The principal goal of Alex John London's (2022, xvii) For the Common Good is to "articulate a new vision for the philosophical foundations of research ethics" which "moves issues of justice from the periphery of the field to the very center." At the core of this new vision is an understanding of research as a "collaborative social activity between free and equal persons," which aims to develop the knowledge public institutions require to establish and maintain a social order in which people may set and pursue their plans of life (London 2022, 3). Clinical and social scientific research are not therefore morally optional activities, in London's view, but rather the way public institutions acquire the knowledge they need to discharge their obligations to create the conditions under which people may enjoy reasonable life spans, develop literacy and numeracy skills, and enjoy their rights to liberty and security. For the Common Good builds on London's prior work, with many chapters featuring revised content from previously published papers. However, it also weaves this work into a broader narrative. Readers familiar with London's work may be struck - as I was - by how well his various contributions of the past 20 years, on topics as diverse as international research ethics, learning health systems, and the purpose of prospective review, fit together into a systematic view. For the Common Good's new vision of research ethics is thus wide-ranging in scope. [End Page E-13] London's new book is a remarkable achievement. It offers a compelling and coherent vision of the philosophical foundations of research ethics, resituating the research enterprise within the broader activity of creating a just social order. By building the foundations of the field on justice, it provides an attractive, systematic alternative to prominent approaches which neglect this value in favor of the principles of beneficence and respect for persons. Despite his focus on the philosophical foundations of research ethics, moreover, London's analysis is informed by his deep knowledge of the practices of research and ethics oversight. The foundations London establishes for the field are thus not only philosophically sound, but appropriate for the construction of norms, rules, and regulations to govern health and social scientific research. In this review, I first provide an overview of London's project before offering several critical comments. Since London's book is incredibly rich and wide-ranging, my comments are necessarily limited in focus, and the issues I take up reflect my own scholarly interests and expertise. There is thus much of value in For the Common Good that I touch on only briefly, if at all. OVERVIEW For the Common Good contains a critical program and a positive program. The critical program outlines the philosophical foundations of "orthodox research ethics" and argues that these foundations are riven with fault lines that threaten to undermine the requirements they are supposed to support (London 2022, 4). Orthodox research ethics, London claims, has eight problematic commitments. First, research involves an inherent moral dilemma, whether between respect for the individual and the good of humanity, or between the clinician's fiduciary duty of care and utilitarian imperatives of the research enterprise (London 2022, 5). It is, second, a morally optional activity between private parties, in which, third, the two main stakeholders are researchers and participants – the "IRB triangle" (London 2022, 6-7). The activity of research is, fourth, defined functionally to involve procedures designed to produce generalizable knowledge which in turn informs a vision of research ethics wherein, fifth, the dueling role obligations of the clinician-researcher take center stage (London 2022, 9). The central aim of regulations is, sixth, to paternalistically protect participants from the potential abuse of researchers (London 2022, 10). Finally, because research is treated as a morally optional activity between private parties, to the extent that justice plays a role in this view, it is, [End Page E-14] seventh, not treated as a value that governs social institutions (London 2022, 11-12), but is instead, eighth, reduced to the principles of respect for persons and beneficence, amounting to voluntary transactions that benefit both...

Ethical Considerations in the Application of Artificial Intelligence to Monitor Social Media for COVID-19 Data.

The COVID-19 pandemic and its related policies (e.g., stay at home and social distancing orders) have increased people’s use of digital technology, such as social media. Researchers have, in turn, utilized artificial intelligence to analyze social media data for public health surveillance. For example, through machine learning and natural language processing, they have monitored social media data to examine public knowledge and behavior. This paper explores the ethical considerations of using artificial intelligence to monitor social media to understand the public’s perspectives and behaviors surrounding COVID-19, including potential risks and benefits of an AI-driven approach. Importantly, investigators and ethics committees have a role in ensuring that researchers adhere to ethical principles of respect for persons, beneficence, and justice in a way that moves science forward while ensuring public safety and confidence in the process.

Africa’s Response to COVID-19 Pandemic and Guiding Ethical Principles

This paper explores Africa’s response to the COVID-19 pandemic and some ethical principles that can be used to address the problem of COVID-19. The COVID-19 pandemic affects all human beings in the world, but not equally. Developing countries are more vulnerable to the COVID-19 crisis. Humanity should act collectively to deal with this crisis. It should search for both indigenous and modern medicines to combat the COVID-19 pandemic. Besides science and technology, humanity should adopt ethical principles, such as the precautionary principle, solidarity, principles of respect for persons, beneficence, nonmaleficence, reciprocity, justice, proportionality, accountability, transparency, and communalism to effectively combat COVID-19. This paper further suggests that pharmaceutical companies should prioritize the well-being of the people, rather than trying to make unnecessary and unreasonable profits in the global fight against the COVID-19 pandemic.

Special Report: Ethical Decision-Making in Contemporary Psychiatric Practice—An Evolving Challenge

Back to table of contents Previous article Next article ProfessionalFull AccessSpecial Report: Ethical Decision-Making in Contemporary Psychiatric Practice—An Evolving ChallengeLaura Weiss Roberts, M.D., M.A., Gabriel Termuehlen, B.A.Laura Weiss RobertsSearch for more papers by this author, M.D., M.A., Gabriel TermuehlenSearch for more papers by this author, B.A.Published Online:27 Dec 2021https://doi.org/10.1176/appi.pn.2022.1.22AbstractPsychiatrists face a distinct set of ethical challenges and professional obligations related to their work. Issues of beneficence, nonmaleficence, confidentiality, altruism, justice and nondiscrimination, professionalism, trust, and related abstract concepts emerge regularly in their treatment of patients.What ethical issues might arise when a psychiatrist includes artificial intelligence decision tools in her clinical practice?Why, and how, should one intervene when a colleague is potentially impaired?In what ways can one safeguard the autonomy of a patient who is living with a severe but intermittent disorder affecting mood and cognition? What ethical tensions might one anticipate and prepare for?Psychiatrists regularly confront both age-old and new questions in their practice, from those that involve the cornerstone values of beneficence and respect to those that involve the cutting edge of technological innovation.Ethics is a formal branch of philosophy that seeks to more deeply understand the moral aspects of human nature and action. Within the profession of medicine, ethics has evolved into an applied discipline. Medical ethics is rooted in formal research and evidence as it emerges from everyday clinical practice, as well as in historical concepts that have endured and evolved over many centuries, such as autonomy, beneficence, nonmaleficence, and justice. This discipline includes specific clinical skills that are as crucial to being a competent and compassionate physician as taking a careful history, evaluating symptoms, and forming a diagnosis.Closely allied with ethics is the concept of professionalism. Professionalism is intrinsically grounded in the ideals of a profession (such as truthfulness, respect for dignity of patients, and humility), although how such ideals are expressed at any given moment in history and in different contexts will change. A profession has moral importance because of the trust and privileges conferred on it by society. Being a member of a profession has moral standing because society requires that professionals possess certain qualities and adhere to a set of duties. The good conduct of members of a profession confirms the investment of power that society has placed in them and in their field, fostering a relationship of trust and equipoise.Psychiatrists face a unique set of ethical challenges and professional obligations related to the specifics of their work. They confront issues of personhood and autonomy, continuously grappling with definitions of health and illness and the very components that make up behavior and identity. Ethical issues of beneficence, nonmaleficence, confidentiality, altruism, justice and nondiscrimination, professionalism, trust, and other seemingly abstract concepts regularly emerge in the daily work of psychiatrists.The second edition of Professionalism and Ethics, Second Edition: Q & A Self-Study Guide for Mental Health Professionals, newly published by American Psychiatric Association Publishing, seeks to encompass everyday ethical challenges with a focus on clinical skills. These skills, like any other, require practice, as past APA President Paul Appelbaum, M.D., emphasizes in a wise introductory comment to the book.“Just as good people do not instinctively follow good diagnostic practices without the training required to do so, just as they cannot be expected to have an intuitive sense of interactions among medications without studying pharmacology, so good people are not necessarily able to avoid the pitfalls inherent in the ethical challenges ubiquitous in clinical work,” Appelbaum writes. “Sound ethical practice, like good psychotherapy, requires a judicious mixture of theoretical knowledge, supervised learning, and reflective practice. And like most other aspects of the job of a clinician, learning ethics takes time and intellectual effort.”New Ethical Challenges in an Evolving LandscapeEach decade brings new, unexpected ethical challenges that evolve over time. Among them:The Neuroscience RevolutionOver the past few decades, neuroscience has taken up a central role in medicine as the conceptual basis for understanding and treating people with mental illness. The study of the brain’s functioning and the recursive application of advancements in our metacognitive understanding to influence the brain and mind carry ethical questions that are not present elsewhere in the biological sciences. These questions belong to the emerging field of “neuroethics.”Examples of topics in neuroethics include the following:Emerging biomedical and neuroimaging technologiesMobile health technology and wearable devicesNeuromodulationNeurotechnology researchThe role of technology in the lives of young peopleBrain death and the definition of deathEthical issues in neurodegenerative conditionsEnvironmental neuroethicsNeurobiology of addictionNeuroscience and the lawNovel Tools and TreatmentsEthical issues accompany the advent of any new diagnostic and evaluative tools. Advances in genetics, genomics, and other biomarkers (such as neuroimaging) hold the potential to bring the practice of psychiatry into the realm of “precision medicine.” Precision psychiatry will raise issues of autonomy (does the patient fully comprehend and voluntarily agree to the use of the diagnostic tool or method?); beneficence (will such novel diagnostic schema have clear benefits for the patient?); nonmaleficence (are there any foreseeable harms associated with the new methods?); and justice (is access to novel diagnostic or evaluative methods fair and nonexploitative of vulnerable populations?).Psychiatric researchers are also exploring a range of novel therapeutic approaches to address unmet needs in patients with mental illness. For example, investigations are ongoing into the potential use of psychedelic compounds (such as psilocybin) for treatment-resistant depression. Novel neurosurgical approaches are also being evaluated for their efficacy in treating patients with psychiatric conditions (including substance use disorders, eating disorders, and neurocognitive disorders). These endeavors raise a number of ethical issues including the following:Ensuring that patients enrolling in novel therapeutics trials provide informed, authentic consentEnsuring that protocols (whether in the research or treatment context) are designed with adequate safeguards for both known potential risks and unforeseen adverse eventsDisseminating accurate, judicious information about the known benefits and risks of these emerging therapiesThe Digital Revolution and Use of ‘Big Data’Emerging methods of prediction in clinical care are bringing a range of new ethical questions to the forefront. The use of machine learning and artificial intelligence to predict illness course or the possibility of specific behaviors (including suicide attempts) may affect the patient-clinician relationship in unexpected ways, for example, by influencing treatment decision-making or the allocation of resources.Algorithmic bias poses great risk in decision-making involving machine learning algorithms, as it can operationalize biases already at work in human decision-making under the guise of sophistication. Transparency about when algorithms are being used and how such algorithms affect patient confidentiality are extremely important. Ensuring adequate communication with patients about algorithms and obtaining proper informed consent are also crucial. It is unfortunate that many algorithms are developed without adequate transparency to stakeholders. Clinicians should consider how algorithms were trained and whether appropriate safeguards were implemented to protect against bias in the context of training (for example, ecological validity of the training data and choice of learning model). There is very little consensus about how to ethically utilize algorithms in clinical care, including for mental health applications.Assisted-Suicide and Physician-Assisted Death LawsIn recent years, the topic of physician-assisted dying (also known as medical aid in dying and physician-assisted suicide) and the related (but distinct) practice of euthanasia have become contentiously debated issues in the United States and many other countries. Physician-assisted dying refers to a physician’s providing either the means or information necessary for a patient to end his or her life. Euthanasia refers to the termination of life by a physician or another clinician. From ethical and legal points of view, assisted dying and euthanasia are distinct from withholding or withdrawing care necessary for continued life. Additionally, assisted dying and euthanasia are viewed as different from administering medications to relieve pain or to bring greater comfort, as the primary intention in this case is not to end the patient’s life. In the United States, physician-assisted dying is legal in some states, while euthanasia remains illegal across the country. APA released a statement in 2016 stating that “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”Concerning data have been reported regarding the use of assisted dying and euthanasia in some European countries for individuals with psychiatric and neurocognitive disorders. Commentators in certain countries have suggested that extending eligibility criteria for euthanasia beyond “reasonably foreseeable natural death” to include psychiatric illnesses could result in ethical conflicts between a patient’s desire to end suffering and limitations in access to specialized psychiatric care, send the implicit message that individuals with chronic or severe psychiatric illnesses do not have lives worth living, erode the ethical principle of nonmaleficence, and contribute to provider moral distress and burnout.Equitable, Patient-Centered CareThe need to include all voices as full partners in clinical care—including individuals with lived experience of mental illness, individuals who seek mental health care services, and underrepresented populations—represents a crucial ethical challenge for psychiatrists today. However, this challenge is “new” only to the extent that it is, at last, more widely recognized and acknowledged; structural inequities in access to care, the quality of care that patients receive, and inequities in research have plagued medicine and psychiatry for generations. Successfully negotiating this moral territory requires a departure from prior, more hierarchical and paternalistic models of care. Mental health professionals need a new set of skills, including the ability to mediate disputes, negotiate power sharing, manage more complex legal situations, and participate in struggles for social justice and political parity, without which adequate mental health care and its funding cannot be achieved.Social MediaOnline platforms and media bring new opportunities and challenges. All psychiatrists need to make conscientious and informed choices about whether, how, what, and how much to interact and disclose online. Given that the majority of psychiatry trainees, and an increasing number of physicians, have social media accounts, outright avoidance or rejection of social media has become impractical. Moreover, these sites now play integral and positive roles for many physicians as facilitators of social interaction. Furthermore, if psychiatrists act carefully and proactively, they can maintain their standards of ethics and professionalism online and ensure appropriate boundaries. Suggested guidelines center around basic issues of trust, privacy, professional standards of conduct, and awareness of potential implications of all digital content and interactions. Simply put, online expression should be viewed as “the new millennium’s elevator,” where psychiatrists have little control over who hears what they say.Where the Rubber Meets the Road: Clinical Skills and Ethical Decision-MakingMental health professionals tend to rely on a set of six core ethics skills. The ability to recognize ethical issues requires some familiarity with key ethics concepts and the interdisciplinary field of bioethics. As a corollary, this ability presupposes the clinician’s capacity to observe and translate complex phenomena into patterns, using the common language of the helping professions (for instance, conflicts among autonomy, beneficence, and justice when a person with mental illness threatens the life of a specific individual and is thus involuntarily held for evaluation).The first of these core skills is the ability to identify ethical issues as they arise. For some, this is an intuitive insight—that is, an internal sense that something is not right—and for others this is derived more logically.The second key ethics skill is the ability to understand how one’s personal values, beliefs, and sense of self may affect one’s care of patients. Attentiveness to interpersonal aspects of the clinician-patient relationship is a crucial safeguard for ethical decision-making by professionals to serve the needs and best interests of patients. In recent years, the role of implicit bias has been identified and studied vigorously, demonstrating the influence of attitudes and social stereotypes related to gender, race, cultural background, and other aspects of identity on many aspects of health care. The impact of implicit bias is felt by patients and health professionals and can adversely affect patient care practices, quality, safety outcomes, and health system policies.The third key ethics skill is an awareness of the limits of one’s own medical knowledge and expertise and the willingness to practice within those limits.The fourth skill is the ability to recognize high-risk situations in which ethical problems are likely to arise. Such circumstances can occur when a mental health professional must step out of the usual treatment relationship to protect the patient or others from harm or to protect the patient’s or others’ best interests, even when the patient may not agree.The fifth skill is the willingness to seek information and consultation when faced with an ethically or clinically difficult situation and the ability to make use of the guidance offered by these sources.The sixth and final essential skill for the mental health professional is the ability to build appropriate ethical safeguards into one’s work.Many clinicians use an eclectic approach to ethical problem-solving that makes intuitive use of principles, case experiences, lessons learned from colleagues, and a combination of inductive and deductive reasoning. Such an approach typically yields not one “right” answer but, rather, an array of possible and ethically justifiable responses that may be acceptable in the specific set of circumstances.A more systematic and explicit approach widely used in the clinical setting is the four-topics method described by Albert Jonsen, Ph.D., and colleagues in the influential 2002 text Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. This method entails gathering and evaluating information about (1) clinical indications, (2) patient preferences, (3) patient quality of life, and (4) contextual or external influences on the ethical decision-making process.Many ethical dilemmas in clinical care involve a conflict between clinical indications and patient preferences. Working through such a dilemma requires exploring fully and thoughtfully the patient’s preferences as well as the clinical indications.Why does the patient refuse treatment? Does the patient have the capacity to make this decision at this time? Is there a range of options, perhaps some that have not been previously considered, that may offer benefit? How urgent is the clinical situation, and is time available for discussion, collaboration, and perhaps compromise?If the patient lacks decision-making capacity, the dilemma is at least temporarily resolved by identifying an appropriate alternative decision-maker. If the patient does have the ability to provide informed consent—involving capacity for decision-making and capacity for voluntarism—then, under most foreseeable circumstances, the patient’s preferences must be followed. However, by engaging the patient in a meaningful dialogue in which the mental health professional describes the full range of treatment options and demonstrates sensitivity to the reasons for the patient’s refusal, it may often be possible to discover a solution that the patient can willingly accept and the clinician can justify as medically beneficial.Informed consent is the process by which individuals make free, knowledgeable decisions about whether to accept a proposed intervention, such as clinical care or research study participation. Informed consent is thus a cornerstone of ethical practice in both treatment and research settings. Although informed consent is a legal requirement in both contexts, its philosophical roots as a medicolegal doctrine are deeply embedded in our societal and cultural respect for individuals and in affirming individuals’ freedom of self-determination. An adequate process of informed consent thus reflects and promotes the ethical principle of autonomy.A model of shared, deliberate decision-making fits with a larger commitment to patient-centered care. Shared decision-making and patient-centered care are grounded in the principle of respect for persons and demonstrate deep regard for the dignity of individuals who receive clinical care. Actions that promote shared decision-making include ensuring that patients are well informed, encouraging patients to play a direct role by making choices and making clear the values and preferences underneath these choices, and protecting and supporting patients’ interests.ConclusionEvery era of medicine has ethical challenges—some new, such as we have experienced with the COVID-19 pandemic and effects of recent extreme weather events caused by climate change, and some not as new, such as how to uproot systemic barriers to equity in the workplace and in the provision of care and how to demonstrate respect for patients’ cultural values, self-governance, and privacy.Psychiatrists and other clinicians caring for people with mental illness and substance use disorders encounter additional and specific ethical concerns, also modern and ancient. The questions and quandaries posed by these ethical issues in everyday clinical practice are thorny, sometimes challenging our own deeply held attitudes and beliefs and engaging the most fundamental aspects of what it means to be a physician.The answers to these problems are nuanced and dependent on multiple factors and context. For these reasons, psychiatrists, trainees, and practitioners in related health fields must understand the requirements of professionalism and cultivate a strong set of skills for making sound ethical decisions. ■WHAT WOULD YOU DO?Case 1: Psychiatrist Asked to Treat an AcquaintanceA 19-year-old has been isolated at home for several weeks after graduating from high school. Her plans for college shifted because of her family’s financial situation and because of an infectious disease pandemic. She made one phone call in an effort to get mental health care, but she could not find sufficient privacy in her home, which is a small apartment. She reached out to a high school friend whose father is a psychiatrist and asked if it would be possible to text the psychiatrist from time to time and to get a prescription for antidepressant medications.What ethical issues and conflicts are present in this clinical scenario?What contextual factors are influencing the situation and the decision and options available to the psychiatrist?What kinds of potential risks exist for this psychiatrist in providing care in this particular situation?How might you handle this situation? What are the most important next steps for the psychiatrist?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?Case 2: Psychiatrist Feels Overextended at WorkA 68-year-old psychiatrist is the sole mental health professional in a multispecialty group practice. The group practice has become increasingly busy: The volume of referrals to the psychiatrist has grown dramatically, and the kinds of patient care situations have become much more severe since a local inpatient unit was closed. The psychiatrist is concerned about stress and has noticed that his notes are not as complete and that he awakens at night, worrying over questions he forgot to ask or problems he failed to address in caring for patients the previous day.What ethical issues and conflicts are present in this clinical scenario?What contextual factors are influencing the situation and the decisions and options available to the psychiatrist?What kinds of potential risks exist for patients and for this psychiatrist in this particular situation?How might you handle this situation? What are the most important next steps for the psychiatrist?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?Case 3: Psychiatry Resident Wishes to Improve Patient CareAn addiction psychiatry trainee is on a three-month rotation in which she provides care for patients in a general mood disorders clinic. She notices that one of the teaching attending psychiatrists seldom asks about addiction-related issues and never asks about safety in the home when evaluating patients. She wishes to raise her concerns, especially regarding female patients with multiple health issues, but she feels very intimidated by the attending psychiatrist, who always seems stressed, irritable, and quick to offer a harsh or negative comment.What ethical issues and conflicts are present in this clinical scenario?What kinds of potential risks exist for patients and for the psychiatry trainee in this particular situation?How might you handle this situation? What are the most important next steps for the psychiatry trainee?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?Case 4: Psychiatrist ‘Stretches’ to Deal With System ChallengesA psychiatrist accepts a telehealth contract to provide consultations on psychiatric patients who come to emergency rooms in a five-county region. The psychiatrist has a full-time “day job” but felt he could handle the extra work and hoped to be able to pay off his school debt more quickly by accepting the added role. The emergency rooms are located in urban and rural community hospitals, which are typically understaffed, and the number of patient evaluations per contracted shift may range from four to 18. The psychiatrist loves the work and feels he is helping to identify patients who are in the greatest immediate need for psychiatric expertise. He also enjoys working with his emergency medicine colleagues, even in this limited way, but worries that a brief telehealth visit does not really help patients in the long run and is just a “Band-Aid” on an inadequate system.What ethical issues are present in this clinical scenario?What inherent risks exist in this situation?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?How are the psychiatrist’s roles as clinician, colleague, and advocate relevant in this scenario?Case 5: Chief Resident Intervenes to Address Team Member DistressA medical student rotating through a psychiatry emergency/crisis clinic for a third-year clerkship becomes extremely distraught after seeing a patient (with the attending psychiatrist) who described her experience surviving childhood sexual abuse. Recognizing the student’s distress, the chief resident met with the student. The student described being upset by the patient’s personal story and the attending psychiatrist’s manner, which the student felt was “insensitive” because of the psychiatrist’s efforts to direct the patient to the “here and now.”What ethical issues are present in this clinical scenario?What inherent risks exist in this situation?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?How are the student’s, attending psychiatrist’s, and chief resident’s roles and professional duties influencing the ethical dimensions of the situation?If you were the chief resident, how might you handle this situation? What are the most important next steps?Case 6: Psychiatrist Asked to Treat VIP PatientA psychiatrist receives a VIP referral from a primary care colleague. The VIP patient is a well-known celebrity who is frequently featured in the news and on social media. The patient is experiencing extreme anxiety after a recent event that “went viral” online. The psychiatrist recognizes the patient’s name and is tempted to investigate the patient’s background and circumstances prior to the initial evaluation.What ethical issues are present in this clinical scenario?What inherent risks exist in this situation?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?How might you handle this situation? What are the most important next steps?Case 7: Psychiatrist Wants to Review Patient Records for Possible Research ProjectA psychiatrist wishes to conduct a quality assurance project that will involve reviewing the electronic medical records of recent psychiatric inpatients to verify the presence of appropriate documentation of sexual history, suicidality, and substance use. The psychiatrist is hoping that eventually there will be an interesting research project to come out of the quality assurance work.What ethical issues are present in this clinical scenario?What inherent risks exist in this situation?What other expertise or resources may be introduced to help or address ethical issues or professionalism challenges in this situation?What issues should the psychiatrist consider in setting up appropriate safeguards for the quality assurance project? And if it becomes a research project? What are the most important next steps?Laura Weiss Roberts, M.D., M.A.Conflict of Interest Disclosure 2021Dr. Laura Roberts serves as the Chairman and Katharine Dexter McCormick and Stanley McCormick Memorial Professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine.Dr. Roberts has received federal funding for competitive, peer-reviewed research grants and competitive, peer-reviewed small business grants and contracts. The key stakeholders, such as Stanford University and the NIH, are fully aware of this arrangement and have given prior approval for this set of professional commitments. In addition, she often serves as a consultant for federally funded scientific projects with collaborators across the United States.Dr. Roberts is the Editor-in-Chief, Books for the American Psychiatric Association Publishing. Funds associated with these duties are provided to Stanford University.Dr. Roberts is the Editor-in-Chief of Academic Medicine, a peer-review publication of the Association of American Medical Colleges. She receives a stipend for this professional service to the AAMC.Dr. Roberts does not receive direct funding from pharmaceutical companies for her work and she is not on any “Speakers’ Bureaus” of any kind. She does give academic and public/community talks for which she receives honoraria.Dr. Roberts has published books and receives royalties. These royalties represent a very small proportion of Dr. Roberts’ overall income. Dr. Roberts has owned Terra Nova Learning Systems (TNLS), a small company that developed science-based educational products in the past.Laura Weiss Roberts, M.D., M.A., is chair of the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine and the Katharine Dexter McCormick and Stanley McCormick Memorial Professor of Psychiatry. She is the co-editor of Professionalism and Ethics, Second Edition: Q & A Self-Study Guide for Mental Health Professionals and editor-in-chief of the books division of APA Publishing.Gabriel Termuehlen, B.A., is an editor in the Department of Psychiatry and Behavioral Sciences in the Stanford University School of Medicine and the book’s co-editor. APA members may purchase the book at a discount here. ISSUES NewArchived

Reconsidering solidarity in an African modified principlism

Principlism has attracted severe criticisms in contemporary bioethical scholarship. Scholars working in bioethics in the sub-Sahara have challenged the autonomy component of principlism, with strong emphasis on solidarity as a more fundamental principle that ought to guide bioethical discourses and practices in Africa and beyond. Focusing on Kevin Gary Behrens, who defends an indigenous Africaninspired version of principlism that incorporates salient African moral values including community, relationality, harmony and solidarity, this article questions the nebulous conception of solidarity in Behrens’ African modified principlism (AMP). AMP is anchored in the principles of respect for persons, beneficence, non-maleficence and harmony. Contra Behrens, I argue that the attempt to replace the American principlist model ‘with a new African-inspired principlist mantra’ can only succeed when there is a thorough analysis of the nature and boundaries of solidarity, which is currently lacking. Advancing on Thaddeus Metz’s construction of solidarity in his ‘Afro-bioethic of communion’, I defend a metaphoric normative conception of solidarity that represents historical symbols of the self and the other in a reflexive-care matrix of identification, recognition, inclusion and empathy. Beyond the partialist frame grounding the understanding of solidarity in African bioethical thought, which is inadequate, I offer a metaphoric, sympathetic and unbound space of solidarity. Suggested for future research is investigating the ranging implications of a metaphoric normative understanding of solidarity for dealing with vulnerable and non-vulnerable groups in the context of healthcare and environmental bioethics at the local, regional and global levels.

Perspectives of buruli ulcer patients toward informed consent - An insight from Nigeria.

Introduction:Informed consent is a basic ethical requirement in situations involving sharing of patients' data. It supports and upholds the ethical principle of respect for persons and individual autonomy. For Buruli ulcer (BU) patients, associated stigma renders them vulnerable, hence the need for emphasis on additional protection by ensuring obtaining informed consent before third party use of their data. The authors therefore sought to determine willingness of these patients to give informed consent to the third party use of their data before and after treatment.Methodology:This cross-sectional study was carried out between February and August, 2019. The study involved BU patients from three endemic states in Nigeria. Data were collected using pretested, researcher-administered semi-structured questionnaires.Results:A total of 92 respondents participated in the study. The median age was 23.5 years (range 4–74 years) with the age group <15 years being the modal age group 36 (39.13%). About a quarter of the respondents (23.91%) had suffered some form of discrimination in the course of their disease. Majority 86 (93.48%) were favorably disposed to allowing the use of their data for donor drive, policy development, and teaching/training purposes. A significant greater proportion of respondents 90 (97.83%) were willing to give consent for the use of their oral interview as against pictures and videos both in the pre- and post-treatment periods.Conclusion:The present study provides evidence that majority of the respondents were positively inclined to give consent to use of their data by a third party. However, intrusion into privacy and anonymity were major concerns for the respondents.

Power-Laden (Mis)Understandings Surrounding Written Voluntary Informed Consent Procedures in Postcolonial Southern Africa

Written voluntary informed consent (VIC) procedures are the standard approach for operationalising the ethical principle of respect for persons’ autonomy in qualitative research. However, achieving fully informed and truly voluntary consent is challenging, particularly in qualitative research and/or postcolonial contexts. Evidence about (mis)understandings (i.e., unintended meanings) surrounding VIC comes primarily from participants in quantitative, biomedical research. I aim to advance knowledge about qualitative research participants’ (mis)understandings of VIC. I used ethnographic methods to document the evolving (mis)understandings participants attached to written VIC procedures in two postcolonial settings, Eswatini and South Africa. All participants provided me consent to document their interactions as co-researchers in participatory research, in which they learned about, designed and implemented VIC procedures. I analysed the data interpretively and abductively, informed by Bourdieu’s theory of practice. Participants valued the opportunity to decide and sign consent to participate but held (mis)understandings of study information and signing, which evolved as they participated. Many (mis)understandings were shaped by what the unfamiliar act of signing symbolised to them (i.e., binding, contractual agreements that protected the researcher/university and through which they relinquished their rights), from their positions of marginalisation amidst economic/material, cultural and social power inequalities. In postcolonial settings, requiring qualitative research participants to sign consent forms likely undermines the ethical principle of respect that VIC is intended to operationalise. Based on these findings I recommend alternative non-written procedures are used to operationalise the principle of respect in postcolonial qualitative research settings.

Person-Oriented Research Ethics to Address the Needs of Participants on the Autism Spectrum.

Research ethics scholarship often attends to vulnerability. People with autism may be vulnerable in research, but are also vulnerable to unjust exclusion from participation. Addressing the needs of participants with autism can facilitate inclusion and honor the bioethics principle of respect for persons while accounting for risk and vulnerability. Drawing from a review of the literature and informed by a moral deliberation process involving a task force of stakeholders (including autistic people and parents of autistic people), we use the model of person-oriented research ethics to identify several practical strategies researchers can use to address these needs and foster inclusion. Strategies include using multiple means of communication, addressing the sensory environment, preparing participants in advance, and accounting for social context. These practical strategies are not just methodological or design choices; they are inherently related to ethical issues. Method and design choices fulfill ethical aspirations by facilitating inclusion, reducing discomfort, and focusing on individuals.